Provider Demographics
NPI:1295787638
Name:CHUNG, ANH DAO T (DO)
Entity type:Individual
Prefix:
First Name:ANH DAO
Middle Name:T
Last Name:CHUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21311 MADRONA AVE
Mailing Address - Street 2:STE 100-A
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5970
Mailing Address - Country:US
Mailing Address - Phone:310-792-4400
Mailing Address - Fax:310-542-5805
Practice Address - Street 1:21311 MADRONA AVE
Practice Address - Street 2:STE 100-A
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5970
Practice Address - Country:US
Practice Address - Phone:310-792-4400
Practice Address - Fax:310-542-5805
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I11392Medicare UPIN
CAW20A8282AMedicare ID - Type UnspecifiedMEDICARE PPIN